Despite the success of the Affordable Care Act (ACA) in bringing near-universal (98.2% of commercially insured US women) screening mammography coverage (with no out-of-pocket costs), its introduction in 2010 was not accompanied by an increase in use.

Use of breast cancer screening peaked in 2009 and steadily declined thereafter, in part because of the unintended consequences of the US Preventive Services Task Force (USPSTF) guideline changes.

Why this matters

Clinicians and patients should be targeted to encourage mammography use.

The percentage of women with zero cost share for breast cancer screening steadily rose from 81.9% in 2004 to 93.1% in 2010, the year of the ACA introduction, and to 92.8% in 2014 (slopepreACA=+0.014 vs slopepostACA=+0.034; P

The percentage of women who used breast cancer screening was low in 2004 (at 36.0%), rose steadily to a peak in 2009 at 42.2%, and then slipped down post-ACA to 39.9% in 2014 (slopepreACA=+0.013 vs slopepostACA=−0.001; P

In 2009, the USPSTF downgraded its recommendation for routine screening mammography among women aged 40 to 49 years, but the adverse effect on use appears to have been widespread because use dropped among all age groups.